European journal of pain : EJP
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Patients with musculoskeletal pain often report limitations in daily functioning due to pain. Recently, the World Health Organisation (WHO) recommended in their International Classification of Functioning, Disability and Health (ICF) to accentuate patients remaining possibilities in functioning instead of focussing on restrictions. In patients with musculoskeletal pain, this would imply that a person's "daily activity level" rather than his/her "disability level" has to be focussed upon. ⋯ Only, 10 out of these 34 instruments contained full or partial information regarding pain specific psychometric properties. At this moment, for quantitative assessment of physical activity, movement registration seems to be favoured based on its higher degree of objectivity in comparison with self report. Taken together more research is needed to evaluate psychometric properties of instruments measuring physical activity in musculoskeletal pain.
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Buprenorphine was not used widely in clinical practice over many years, mainly due to analgesic potency and clinical safety concerns based on misinterpreted animal data. Contrary to previous concerns, however, no analgesic ceiling effect and no antagonism of combined pure mu-opioid receptor agonists is seen within the therapeutic dose range. In recent studies, buprenorphine could be effectively and safely combined with full mu-agonists, and switching between buprenorphine and another opioid provided comparable pain relief based on equianalgesic doses. ⋯ In clinical trials, patients receiving transdermal buprenorphine experienced significantly greater pain relief, better sleep, and a reduced need for rescue therapy, compared to placebo. Large-scale post-marketing studies have confirmed the effectiveness of transdermal buprenorphine in treating moderate-to-severe cancer and non-cancer pain including neuropathic syndromes. Finally, the comparably low incidence of CNS adverse events and constipation, and the possibility of use in severe renal dysfunction without a need for dose adjustment make buprenorphine well suited for chronic pain management in at-risk patients, such as diabetics, elderly or renally impaired individuals including those requiring haemodialysis.
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Experimental findings on the influence of dementia on pain have so far been conflicting. There is evidence for a decreased, an unchanged and even for an increased pain processing in patients with dementia. The present study was conducted to add on the description of the impact of dementia on pain processing by assessing multiple components of pain (subjective, facial, motor reflex and autonomic responses) in parallel in one group of demented patients. ⋯ In conclusion, dementia tends to affect different pain components in different ways. Therefore, the assessment of pain in patients with dementia should be based on the measurement of multiple components of pain and not solely on subjective self-report ratings. Furthermore, taking into account our findings on facial responses and the NFR, we think that there is sufficient evidence suggesting a rather intensified processing of noxious stimulation in this patient group.
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This prospective study investigated how pain catastrophizing was related to labor pain intensity and physical recovery after childbirth. Eighty-eight women giving birth for the first time completed the first questionnaire before delivery. Eighty-two of those returned the second questionnaire after delivery. ⋯ These results extend the association between catastrophizing and pain, to pain and recovery in childbirth and provide support for the fear-avoidance model. It is concluded that pain catastrophizing plays a role in the experience of pain in childbirth and postpartum recovery. Further research is needed to identify appropriate interventions for catastrophizing women during the latter part of pregnancy.
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Beliefs about pain conditions appear to influence recovery in a variety of musculoskeletal conditions. Little is known about population beliefs about neck and arm pain. ⋯ Population beliefs related to neck pain, arm pain, and WAD in the two Canadian provinces sampled were consistent with the literature in regard to remaining active, but appeared misinformed relating to the prognosis of these conditions. Strategies for reeducating the public are indicated.